Early and late outcomes after trans-catheter aortic valve implantation in patients with previous chest radiation
| Autor: | Phalla Ou, Myriam Amsallem, Benjamin Alos, Alec Vahanian, Eric Brochet, Aziza Touati, Walid Ghodbane, Dominique Himbert, Patrick Nataf, Marie-Pierre Dilly, Bernard Iung, Claire Bouleti, Marina Urena |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Aortic valve medicine.medical_specialty Time Factors Population 030204 cardiovascular system & hematology Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Internal medicine Epidemiology medicine Humans Radiation Injuries education Survival analysis Aged Cause of death Aged 80 and over education.field_of_study business.industry Aortic Valve Stenosis Middle Aged Thorax Prognosis medicine.disease Survival Analysis Surgery Hospitalization Catheter Stenosis Treatment Outcome medicine.anatomical_structure Respiratory failure Echocardiography Case-Control Studies 030220 oncology & carcinogenesis Cardiology Female Respiratory Insufficiency Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Heart. 102:1044-1051 |
| ISSN: | 1468-201X 1355-6037 |
| DOI: | 10.1136/heartjnl-2015-309101 |
| Popis: | Surgery for aortic stenosis in patients with thoracic radiation therapy is associated with high morbi-mortality. Trans-catheter aortic valve implantation (TAVI) represents an alternative but has never been studied in this population. We aimed to compare outcomes in radiation and matched control patients undergoing TAVI and to identify predictive factors of survival.Between 2006 and 2011, 288 consecutive patients underwent TAVI in our institution, of whom 26 had previous chest radiation. They were matched 1:1 for age, sex and TAVI approach with controls.In both groups, median age was 73 years, 50% of patients were male and 15% had a transapical approach. Procedural success was 88% in the radiation group versus 100% in controls (p0.001) and 30-day survival was 92% in both groups. Five-year survival was 33%±10% in the radiation group and 42%±11% in controls (p=0.26). In radiation patients, the main cause of death was respiratory insufficiency in 40%. We identified four independent predictive factors of death in the radiation group: extracardiac arteriopathy (p=0.002) and the absence of β-blocker therapy (p=0.005) as preprocedural variables, and infectious complications (p=0.009) and a higher peak creatinine level (p=0.009) as postprocedural variables. In the radiation group, 89% of survivors were in New York Heart Association class I-II at last follow-up.Patients in the radiation group displayed high mortality rates although not significantly different from the controls. Respiratory failure was the main cause of death, emphasising the need for a careful pulmonary evaluation. Finally, we show a sustained improvement in functional results after TAVI in this population. |
| Databáze: | OpenAIRE |
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